=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083338123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAVREEL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2022
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 GROSSMAN DR STE 205
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184-4947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-945-8655
-----------------------------------------------------
Fax | 617-608-0674
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 GROSSMAN DR STE 205
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184-4947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-945-8655
-----------------------------------------------------
Fax | 617-608-0674
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | RICHARD W DE JESUS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-945-8655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------